Takayasu Arteritis

Takayasu arteritis is a chronic disorder with symptoms that fluctuate in severity.

Sometimes the disorder begins with fever, muscle and joint aches, loss of appetite, weight loss, and night sweats. But usually, symptoms occur when an artery narrows, reducing blood flow to part of the body, as in the following:

Some people do not have any symptoms. In other people, the disorder progresses, causing serious complications such as strokes, heart failure, heart attacks, kidney failure, and aneurysms.

Doctors suspect Takayasu arteritis based on the following, especially in young women:

Doctors ask about symptoms, review the person’s medical history, and do a complete physical examination to exclude other disorders that may cause similar symptoms. Doctors measure blood pressure in both arms and both legs. Arms and legs that have lower blood pressure may have narrowed arteries. To get an accurate blood pressure measurement, doctors measure blood pressure in a limb where arteries have not been narrowed by the disease.

Blood tests and urine tests are done. They cannot identify the disorder but may confirm that inflammation is present.

To confirm the diagnosis of Takayasu arteritis, doctors do imaging tests such as magnetic resonance angiography Magnetic resonance angiography (MRA) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more or computed tomography (CT) angiography CT angiography In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more , or sometimes conventional angiography Angiography In angiography, x-rays are used to produce detailed images of blood vessels. It is sometimes called conventional angiography to distinguish it from computed tomography (CT) angiography and magnetic... read more (also called arteriography), to evaluate the aorta and its branches. For conventional or CT angiography, a contrast agent that can be seen on x-rays (radiopaque contrast agent) is injected into blood vessels to outline them. Then x-rays are taken. Magnetic resonance angiography does not require the injection of a dye. These procedures can detect aneurysms and show where the arteries are narrowed and where the vessel walls are thickened.

After Takayasu arteritis is diagnosed, regular doctor visits should be scheduled so that the doctor can check whether the disorder is progressing.

For 20% of people, the disorder occurs once and does not return. For the rest, the disorder goes away and returns or is chronic and progressively worsens. Even when symptoms and laboratory test abnormalities suggest the disorder is not active, new symptoms occur or an abnormality is seen during imaging studies. The prognosis is poorer for people whose disorder is progressively worsening and who have complications (such as high blood pressure, heart failure, or aneurysms).

Corticosteroids (such as prednisone) are usually used. They effectively reduce inflammation in most people. Sometimes another drug that suppresses the immune system Overview of the Immune System The immune system is designed to defend the body against foreign or dangerous invaders. Such invaders include Microorganisms (commonly called germs, such as bacteria, viruses, and fungi) Parasites... read more (immunosuppressant), such as azathioprine, cyclophosphamide, mycophenolate mofetil, or methotrexate, is also used. Tumor necrosis factor inhibitors, such as infliximab, may also be effective. Tocilizumab, another drug that decreases inflammation, may help some people. However, drugs may not completely control symptoms in about one fourth of people.

How long drugs should be given has not been determined. The dose of the corticosteroid is gradually reduced, and the drug is eventually stopped because these drugs, especially when used for a long time, can have serious side effects. When drugs are stopped, symptoms return in about one half of people, so the drugs may need to be restarted.

High blood pressure must be controlled to prevent complications (see Treatment of High Blood Pressure Treatment High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more ). Angiotensin-converting enzyme (ACE) inhibitors are often used. Taking a low dose of aspirin is usually recommended to help decrease the risk of clotting in the inflamed artery, which can lead to blockages. If an artery that supplies the heart is blocked, a heart attack can result.

Bypass surgery may be used to re-establish blood flow. For example, if people have difficulty using their arms or walking, bypass surgery may be done to restore the blood flow to the affected limb. Another bypass surgery, coronary artery bypass grafting Coronary Artery Bypass Grafting Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more , may be needed to restore blood flow to heart muscle if the arteritis affects the heart arteries. Alternatively, a procedure such as percutaneous transluminal coronary angioplasty Percutaneous Coronary Intervention Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more ) may be used, depending on the symptoms, but may not work as well as bypass surgery.

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